Ariel K. Saad

Leflunomide-Induced Pulmonary Hypertension in a Young Woman with Rheumatoid Arthritis: A Case Report

Leflunomide, a disease-modifying antirheumatic drug, has been shown to be effective in the management of rheumatoid arthritis (RA). Among other side effects, systemic hypertension has been described, and also a case of possible pulmonary hypertension (PH) has been reported. Symptomatic PH in RA is rare. We present a 28-year-old woman with a history of RA who consulted our hospital because of severe symptomatic pulmonary hypertension. Two years before admission, she was started on leflunomide. Due to previous evidence of the association of leflunomide with pulmonary hypertension, the drug was stopped. The patient became asymptomatic with normal pulmonary arterial pressure within a year. Given the poor prognosis of idiopathic pulmonary arterial hypertension, the recognition of potentially reversible causes is crucial. Until further evidence is available in a patient who develops pulmonary arterial hypertension, stopping leflunomide should be considered.

Left Ventricle Functional Assessment by Three-Dimensional Echocardiography in Patients with Systemic Lupus Erythematosus

Background: Systemic lupus erythematosus frequently presents subclinical myocardial involvement; this has an early onset and predicts mortality. The analysis of myocardial deformation (strain) by three-dimensional speckle tracking echocardiography could be useful in the assessment of myocardial function. Objective: The aim of this study was to assess left ventricular structure and systolic function through the analysis of threedimensional deformation. Methods: Thirty seven women with systemic lupus erythematosus (age 35±10 years) and no history of structural heart disease and 20 controls (34±8 years) were included in the study. Two-dimensional and three-dimensional echocardiography was performed according to the recommendations of the American Society of Echocardiography to acquire global longitudinal strain, radial strain, circumferential strain and strain area. Systemic lupus erythematosus activity was estimated with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI), considering a score ≥4 as active disease. Results: There were no differences in age, risk factors, blood pressure, and heart rate between both groups. From a structural point of view, both atria presented larger size in the systemic lupus erythematosus group. This group of patients presented lower global longitudinal strain (-19.7±2.7 vs. -21.1±2.5, p=0.009), global radial strain (50.7±8.7 vs. 56.5±5.6; p=0.02) and global strain area (-32.1±3.9 vs. -34.7±2.1, p=0.004). This decrease was even more marked in women with active systemic lupus erythematosus. Conclusions: All deformation parameters were reduced in patients with systemic lupus erythematosus, which could be due to incipient alterations of left ventricular systolic function.

SAT0158 Assessment of Systolic and Diastolic Cardiac Function by Tissue Echo Doppler in Ambulatory Patients with Rheumatoid Arthritis

Background Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects 1% of the worlds population. Patients with RA are at increased risk of cardiovascular disease (CVD) and they have lower survivals than the general population mainly due to an accelerated atherosclerosis caused by inflammatory mechanisms. The early detection of subclinical CVD could allow a more aggressive treatment of risk factors. Objectives The purpose of this study was to analyze systolic and diastolic cardiac function by echocardiography and tissue Doppler imaging in patients with RA as well as to compare them with a control group. Methods Eighty two patients with RA (ACR/EULAR, 2010) and 17 of the control group were studied. Patients with atrial fibrillation, diabetes and known structural heart disease of any etiology were excluded. A 2D echocardiography, echo-Doppler and tissue Doppler were achieved following the recommendations of the American Society of Echocardiography. Categorical variables were compared with χ2 test while the continuous ones were compared with the T test. A p<0.05 was considered statistically significant. Results Seventy-five patients with RA (mean age 55±13 years, 95% female) and 16 controls (mean age 51±18 years, 88% female) were included. Median time from diagnosis of RA 10.7 (±9.2) years. There were no differences in sex, age, prevalence of cardiovascular risk factors, arterial pressure and anthropometric measures between the two groups. Patients with RA had greater left atrium dimensions, higher systolic pulmonary pressure and higher E/e ratio in both ventricles than the control group. On the contrary, patients with RA had a lower tricuspid and mitral systolic annular plane excursion and a lower systolic left ventricular tissue Doppler velocity. In the following table we describe the most relevant findings. Conclusions Presence of premature disturbances in both systolic and diastolic heart function was found in RA patients compared with control group. Early detection of patients at increased risk of coronary artery disease would allow early treatment and improved survival. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6060

AB0332 Echocardiographic Assessment of Ambulatory Rheumatoid Arthritis Patients with and without Periodontitis

Background Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects 1% of the worlds population. Patients with RA are at increased risk of cardiovascular disease (CVD) and they have lower survivals rates than the general population mainly due to an accelerated atherosclerosis caused by inflammatory mechanisms. Periodontitis (PO) is frequent in patients with RA and is also associated with systemic inflammation. The coexistence of both processes could potentiate the cardiovascular impact of RA. Objectives The purpose of this study was to evaluate systolic and diastolic cardiac function by echocardiography and tissue Doppler imaging in patients with RA with and without PO. Methods Patients with diagnosis of RA (ACR/EULAR, 2010) were included. Exclusion criteria were atrial fibrillation and known structural heart disease of any etiology. All patients underwent odontologic evaluation, 2D echocardiography, echo-Doppler and tissue Doppler imaging following recommendations of the American Society of Echocardiography. Patients were classified into 3 groups according to the presence of PO (G1: no PO, G2: mild PO, G3: moderate/severe PO). Categorical variables were compared with χ2 test and continuous variables were compared with ANOVA. A p<0.05 was considered statistically significant. Results Seventy-two patients with RA (mean age 55±13 years, 96% female) were included. Forty one patients were classified in G1, 16 in G2 and 15 in G3. There were no significant differences in age, prevalence of cardiovascular risk factors, anthropometric measures and time since diagnosis of RA between groups. G3 had a higher prevalence of male sex (G3: 20%, G1: 0% and G2: 0%; p=0,002). Table 1 shows the main results of echocardiographic evaluation. There were no significant differences between groups in structural, systolic or dyastolic parameters. Conclusions In this cohort of patients, periodontitis was not associated with structural or functional heart changes as assessed by comprehensive echocardiographic evaluation. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6069

FRI0060 Carotid Doppler Assessment of Ambulatory Rheumatoid Arthritis Patients with and without Periodontitis

Background Atherosclerotic cardiovascular disease (ACVD) is the leading cause of death worldwide. Carotid atherosclerosis is one of its manifestations and can be assessed noninvasively by ultrasound. Systemic inflammation is a risk factor for developing ACVD. Rheumatoid arthritis (RA) and periodontitis (PO) are associated with the development of systemic inflammation and ACVD, however the role of the PO is controversial as potential confounders such as smoking and diabetes are independent risk factors for both PO to ACVD. Objectives To evaluate whether moderate or severe PO is independently associated with the presence of carotid atherosclerotic disease in patients with RA. Methods An observational, cross-section study was performed. Patients diagnosed with RA (ACR/EULAR 2010) in ambulatory monitoring were included. We excluded those with known cardiovascular disease (heart attack, stroke, heart failure and valvular disease). All participants underwent a clinical evaluation, laboratory tests, dental evaluation and carotid Doppler ultrasound (measurement of intima-media thickness and detection of atheromatous plaques) according to the recommendations of the American Heart Association. The population was divided into 2 groups (G1: with moderate or severe PO and G2: no PO or mild PO). For the analysis of categorical variables, Chi 2 was used (or Fisher exact correction as necessary) and for continuous variables Student test was applied. In all cases a P value less than 0.05 was considered significant. Multivariate analysis was performed using logistic or linear regression as was applicable for adjusting for sex, age, smoking, and diabetes, among other variables. Results Seventy two patients with RA were included, mean age 54.8 (±3.6) years, 93.9% female, median time from diagnosis of RA 10.7 (±9.2) years. Thirty-one patients (43.1%) had PO. Fifteen patients (20.8%) belonged to the G2. G2 patients had a trend to older age but did not reach statistical significance (60.7±10.2 vs 53.2±14.3, P=0.054) and higher prevalence of males (20% vs 0%, P<0.001). No statistically significant differences in the prevalence of other risk factors, anthropometric measurements and blood pressure were evident. Table 1 shows the main findings in univariate analysis. G2 patients had a higher prevalence of bilateral carotid plaque and increased maximum EIM. When multivariate analysis adjusting for age, sex, smoking and diabetes were conducted no significant differences between groups for the presence of plaques and intima-media thickness showed up. Conclusions In this cohort of patients with rheumatoid arthritis, the presence of moderate or severe periodontitis was not associated with the presence of carotid atheromatous lesions. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6065